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OVI Blood and/or Urine



For the blood and urine sample of the person John doe, dob 1/8/1950, age 55, a white male,  ssn: 123-45-6789


STATE OF OHIO                                                                    MARYSIVLLE MUNICIPAL COURT                                                                                             : ss                                    

COUNTY OF UNION                                                             MARYSVILLE, OHIO        


            Before me, the undersigned, Judge of a court of record within and for Union County, Ohio, personally appeared Detective ____________________ of the Union County Sheriff’s Office, who being duly sworn according to law, deposes and says that he has good cause to believe and does believe that pursuant to 2933 R.C. and Rule 41 of the Ohio Rules of Criminal Procedure, evidence of the commission of the criminal offenses of the Ohio Revised Code Sections 4511.19 OVI, AND AGGRAVATED VEHICULAR HOMICIDE, 2903.06.


The undersigned applicant being duly sworn, _____________________, a law enforcement officer in and for the State of Ohio, and the applicant herein, states that specimens of blood will be found in the body of or as part of the property of ___________________________, (the alleged offender) SSN ____________ DOB ____________.

Based upon my training and experience, a sample of whole blood, blood serum, plasma or urine can be tested and foresically tested to determine the blood alcohol and/or level of drugs in the system of the offender at the time of the operation of a vehicle.  Said sample has evidentiary value. 

Operation of a Vehicle:  The applicant here has personally investigated and observed facts, or, as indicated below, has gathered facts from other law enforcement officers who are believed by me to be reliable, which indicate that the alleged offender was operating a motor vehicle in Union County, Ohio, on the ___ day of________, 20__ at approximately ____ hours.  Through __ witness statements __ admissions of the offender or __by observations of the investigating officer has probable cause to believe and does believe that  ___________________________was the vehicle operator of the _______________________________________, a vehicle involved in the crash on said date,  TO WIT: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

Observations of drug/alcohol usage:  Applicant further states s/he has been trained to observe and document indicators of impairment by alcohol and/or drugs through the basic police academy and the Advanced Detection and Prosecution of impaired drivers (ADAP), to wit:____________________________________________________________

I have the following experience in the investigation of impaired drivers, to wit: __________________________________

that upon contact with the offender the following were observed by me, which based upon my training and experience __________________________________________: __ strong __ moderate __ slight odor of an alcoholic beverage on the breath of the offender and    __ information from others involved.  The offender’s eyes were __ glassy __ bloodshot __ red __ watery __ other (describe)_______________.  The offender was __ unsteady on his/her feet    __ speech was __ slurred or unintelligible __ mood swings were evident __admitted to consuming          __ drugs  __ alcohol prior to or during operation of the vehicle.  The alleged offender’s statements included, but are not limited to:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

There was __ beverage container(s) or __drug paraphernalia and/or __other (describe) _______________________

____________________________________________________________________________________________ were found in the vehicle and/or on the alleged offender’s person.

Other indicia of impairment include:____________________________________________________________________

Divided attention skills testing:  I have been trained to administer and did administer standardized field sobriety testing (SFTs)upon the offender.  Said SFTs have been developed and and test by the National Highway Traffic Safety Administration.  ___The tests were administered in accordance with standardized protocols/ ____were not administered because __________________________________________________________________________.  Applicant further states that the offender __ refused S.F.S.T. at the scene of the accident or __ performed __ walk and turn __ horizontal gaznystagmus with __ clues demonstrated __ one leg stand.  He/she __ consented __ refused portable breath test with ___________results.  The applicant’s observations of these tests include the following:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

Injury and/or death of other persons:  The applicant further states that the offender was involved in motor vehicle crash which occurred at the location of_______________________________________________in _______________County, Ohio.  The crash caused ____the death  of _______________________________________________________________

___serious physical injury to __________________________________________________________________________

Refusal of chemical test:

  _____The offender has refused, contrary to Ohio law, R.C. 4511.191, to provide a sample of blood, serum, and/or urine after being requested to do so after arrest and being advised of the consequences of submitting to a test or refusing, and was read and shown documents provided by the Ohio Bureau of Motor Vehicles, to wit, form BMV 2255.

The applicant states based upon his/her training and experience considering all the facts and circumstances observed or relayed to him/her including all tests completed or attempted (which provided information that caused the investigating officer to form the opinion that the offender was under the influence) of alcohol, drug abuse, alcohol and drug abuse at the time of operating the motor vehicle.

The above described alleged offender is presently located at ____________________________________________within the jurisdiction of this court,  and an emergency exists to ensure timely preservation of vital evidence.  The body metabolizes and excretes alcohol and/or drugs, and the passage of time will diminish the evidentiary value of the sample.

The undersigned requests that a Warrant be issued to seize samples of blood, urine, and/or serum either from the alleged offender, or samples have been taken and are in the possession of others, then an order to seize such samples.  Blood/urine/serum samples using a public safety draw kit should be obtained in addition to any other seized, and the samples should be taken immediately to avoid diminution in the evidence and in accordance with the law because they are evidence of the crimes.

 Time is of the essence. ______ A nighttime search warrant is requested. The body metabolizes and excretes alcohol and/or drugs, and the passage of time will diminish the evidentiary value of the sample.


Reviewed By Prosecutor  ___________________







Sworn to before me and subscribed in my presence this ________ day of ____________________, 20__________.












commanding the seizure of the blood and urine of the person John doe, dob 1/8/1950, age 55, a white male,  ssn: 123-45-6789



STATE OF OHIO                                                                    UNION COUNTY JUVENILE COURT                                                                                                     : ss                                    

COUNTY OF UNION                                                             MARYSVILLE, OHIO        


To: Sheriff Malcum “Jamie” Patton, Union County Sheriff’s Office, Greetings:


            WHEREAS, there has been filed with me an affidavit, a copy of which appears attached hereto, and is incorporated herein, that the affiant has reason to believe that evidence in the form of whole blood, blood plasma, blood serum and urine of the person of: _________________________________________________which is evidence of the crime of ___Operating While Under the Influence 4511.19 and ____Aggravated Vehicular Homicide, 2903.06.


Therefore, I find sufficient probable cause to believe that said evidence may be found within the body of said person;

You are to cause the search and seizure of ______________________________________ SSN ____________________ DOB____________ at _________________________, where a specimen of blood, which is evidence of the presence of drugs and/or alcohol shall be seized with or without the cooperation of the alleged offender, including by forcibly seizure, by a physician, nurse, technician, or phlebotomist within Union County, Ohio, anytime of the day or night.


Such assistance as necessary to properly restrain the alleged offender may be employed to obtain the necessary specimens.  I am satisfied that there is probable cause to believe that the property so described is being concealed on the person above described and that the foregoing grounds for application for issuance of the search warrant pursuant to Rule 41(B) of the Ohio Rules of Criminal Procedure exist.   This Warrant SHALL be served immediately and the search is to be made immediately whether daytime or night because I find that reasonable cause has been shown authorizing the execution of the search warrant need be immediate no matter day or night and may be carried out at a time other than daytime.  Thereafter, return the said Warrant noting by inventory the specimens received and immediately transmit said specimens for proper forensic analysis.


You are further commanded to bring the same or any part thereof, found on such search, forthwith be me, or some other judge of this court having cognizance thereof, to be disposed of and dealt with according to law. In lieu thereof, you are authorized to retain such seized property and/or evidence in the property room of the Union County Sheriff’s Office.


____NIGHTIME SEARCH WARRANT IS AUTHORIZED                                                                                                                                                                                                     _________________________________________





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